Provider Demographics
NPI:1750935425
Name:THOMPSON, DARYN LEE (MED)
Entity type:Individual
Prefix:
First Name:DARYN
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DAISY PL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1365
Mailing Address - Country:US
Mailing Address - Phone:678-675-9120
Mailing Address - Fax:
Practice Address - Street 1:3925 GALLATIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2405
Practice Address - Country:US
Practice Address - Phone:615-682-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional